Delayed presentation of intraperitoneal bladder perforation after blunt abdominal injury mimicking an acute abdomen: A case report and literature review.

INTRODUCTION

Urinary tract injuries occur in 10 % to 15 % of cases of blunt or penetrating abdominal trauma. Urinary bladder perforation happens in 15 % of pelvic fractures and can be intraperitoneal, extraperitoneal, or mixed. Delayed diagnosis of an intraperitoneal bladder perforation is uncommon in the post-computer tomography era. Failure to identify and treat it promptly could lead to a potentially fatal complication.

CASE PRESENTATION: We report a case of a 38-year-old man with a delayed diagnosis of traumatic intraperitoneal bladder perforation, occurring two weeks after a blunt assault in which he was kicked in the lower abdomen. He initially presented with a distended abdomen and kidney injury following the alleged assault. To our knowledge, this represents the most extended delay in diagnosing intraperitoneal bladder perforation and serves as a valuable learning point in the assessment of patients with suspected blunt bladder injury.

CLINICAL DISCUSSION: Several known mechanisms can cause bladder rupture, such as a pelvic fracture leading to either direct perforation by bone fragments or indirect traction on surrounding ligaments. When an overdistended bladder is compressed or subjected to violent deceleration, isolated ruptures may occur. Diagnosis can be delayed because it is often not considered in the differential diagnosis of an acute abdomen or oliguria, thus requiring a high index of suspicion. A computed tomography cystography scan is the most effective imaging method, with nearly 100 % sensitivity in diagnosing clinically significant bladder damage.

CONCLUSION

Bladder rupture, a rare but serious cause of acute abdomen following blunt trauma, requires prompt computed tomography cystography for diagnosis, with surgical repair for intraperitoneal bladder rupture.